title: Inverted mitral inflow pattern in echocardiography among the elderly--a marker of non-cardiovascular mortality and cognitive dysfunction.
abstract: BACKGROUND
  An echocardiographically measured inverted mitral inflow pattern (E/A ratio), a measure of left ventricular diastolic function, has been repeatedly shown to predict mortality. Despite its known association with several non-cardiovascular disease states, its connection to non-cardiovascular mortality remains unknown.
  
  
  METHODS
  A total of 323 individuals aged more than 75 years were examined and followed up for a median of 7.6 years in a prospective population-based echocardiographic cohort study carried out in Eastern Finland. Cox proportional hazards regression models were used to determine the prognostic power of echocardiographic parameters on total, cardiovascular, and non-cardiovascular mortality, with special interest on inverted E/A ratio.
  
  
  RESULTS
  The left ventricular mass index was a significant predictor of total and cardiovascular mortality. It had no connection to non-cardiovascular mortality. Inverted E/A ratio was associated with total mortality in the age- and sex-adjusted (HR = 1.54; 95% CI = 1.14-2.07) as well as in the fully adjusted multivariable model (HR = 1.55; 95% CI = 1.10-2.19). Regarding cardiovascular mortality, the inverted E/A ratio showed no predictive value in the age- and sex-adjusted (HR = 1.24; 95% CI = 0.80-1.91) or the fully adjusted (HR = 1.31; 95% CI = 0.78-2.22) models. Inverted E/A was a strong predictor of non-cardiovascular mortality in both the age- and sex-adjusted model (HR = 1.86; 95% CI = 1.24-2.80) and the multivariable model (HR = 1.81; 95% CI = 1.13-2.89). Dementive illness was the only prior disease more common among individuals with an inverted mitral inflow pattern.
  
  
  CONCLUSIONS
  An echocardiographically measured inverted mitral inflow pattern is a robust predictor of total and non-cardiovascular mortality among the elderly general population, with no significant connection to cardiovascular mortality.
authors.affiliation: Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland. tuomas.kerola@phsotey.fi
authors.forename: Tuomas
authors.initials: T
authors.lastname: Kerola
authors.forename: Tuomo
authors.initials: T
authors.lastname: Nieminen
authors.forename: Raimo
authors.initials: R
authors.lastname: Sulkava
authors.forename: Olli
authors.initials: O
authors.lastname: Vuolteenaho
authors.forename: Sirpa
authors.initials: S
authors.lastname: Hartikainen
authors.forename: Raimo
authors.initials: R
authors.lastname: Kettunen
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000503:physiopathology; D015331:Cohort Studies; D004452:Echocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000503:physiopathology*; D011446:Prospective Studies; D016277:Ventricular Function, Left